Healthcare Provider Details

I. General information

NPI: 1578485157
Provider Name (Legal Business Name): WELLNESS ENTREATED & RESTORED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 BEARDS HILL RD STE 101M-122
ABERDEEN MD
21001-2293
US

IV. Provider business mailing address

1013 BEARDS HILL RD STE 101-M122
ABERDEEN MD
21001-2293
US

V. Phone/Fax

Practice location:
  • Phone: 718-236-0774
  • Fax: 410-272-4750
Mailing address:
  • Phone: 718-236-0774
  • Fax: 410-272-4750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMARA ROSITA RUNCIE
Title or Position: OWNER/PROVIDER
Credential: LMHC, LCPC
Phone: 347-656-0174